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1.
Rev. méd. Chile ; 151(4): 518-523, abr. 2023. tab, ilus
Artigo em Espanhol | LILACS | ID: biblio-1560193

RESUMO

The relief of the impediment to urinary flow is the treatment of acute kidney failure due to urinary tract obstruction. However, there is a risk of inducing massive polyuria, which can be self-limited or produce severe contraction of the intravascular volume with pre-renal acute kidney failure and alterations in the internal environment. Polyuria, urine output > 3 L/d or > 200 mL/min for more than 2 hours, can have multiple causes, and can be classified as osmotic, aqueous or mixed. Post-obstructive polyuria obeys different pathogenic mechanisms, which overlap and vary during a patient's evolution. Initially, there is a decrease in vasoconstrictor factors and an increase in renal blood flow, which, added to the excess of urea accumulated, will cause intense osmotic diuresis (osmotic polyuria due to urea). Added to these factors are the positive sodium and water balance during acute renal failure, plus the contributions of crystalloid solutions to replace diuresis (ionic osmotic polyuria). Finally, there may be tubular dysfunction and decreased solutes in the renal medullary interstitium, adding resistance to the action of vasopressin. The latter causes a loss of free water (mixed polyuria). We present the case of a patient with post-obstructive polyuria where, by analyzing the clinical symptoms and laboratory alterations, it was possible to interpret the mechanisms of polyuria and administer appropriate treatment for the pathogenic mechanism.


Assuntos
Humanos , Masculino , Pessoa de Meia-Idade , Poliúria/etiologia , Poliúria/fisiopatologia , Obstrução Ureteral/complicações , Obstrução Ureteral/fisiopatologia , Obstrução Uretral/fisiopatologia
2.
Rev. méd. Chile ; 151(3): 313-320, mar. 2023. tab, graf
Artigo em Espanhol | LILACS | ID: biblio-1530256

RESUMO

BACKGROUND: Treatment for moderate-severe active ulcerative colitis (UC) includes steroids, biologic therapy and total colectomy. Aim: To describe the features of patients with moderate to severe active UC, their hospital evolution and need for colectomy. MATERIAL AND METHODS: Non-concurrent cohort study of all patients admitted to our institution with a diagnosis of moderate or severe UC crisis between January 2008 and May 2019. Truelove Witts (TW) criteria were used to categorize disease severity. Twelve-month colectomy-free survival was estimated with Kaplan-Meier survival analysis. Results: One hundred-twenty patients aged 16 to 89 (median 35) years had 160 admissions for acute moderate to severe UC. Median admission per patient was 1 (1-3), and median hospital stay was six days (1-49). Cytomegalovirus and Clostridioides difficile were found in 17.5 and 14.2% of crises, respectively. Corticosteroids were used in all crises and biologic therapy in 6.9% of them. Emergency or elective colectomies were performed in 18.3 and 6.7% of patients, respectively. The need for emergency total colectomy decreased from 24.6 to 7.8% (Risk ratio 3.16, p < 0.01) between de first and second half of the study period. Kaplan-Meier analysis for long term colectomy-free survival in both periods confirmed this decrease (p < 0.01). CONCLUSIONS: Medical treatment for moderate to severe UC crises had a 86.3% success and a small percentage required emergency total colectomy. Emergency surgery decreased in the last decade.


Assuntos
Humanos , Colite Ulcerativa/cirurgia , Colite Ulcerativa/tratamento farmacológico , Fármacos Gastrointestinais/uso terapêutico , Resultado do Tratamento , Colectomia , Infliximab/uso terapêutico
3.
Rev Med Chil ; 151(4): 518-523, 2023 Apr.
Artigo em Espanhol | MEDLINE | ID: mdl-38687528

RESUMO

The relief of the impediment to urinary flow is the treatment of acute kidney failure due to urinary tract obstruction. However, there is a risk of inducing massive polyuria, which can be self-limited or produce severe contraction of the intravascular volume with pre-renal acute kidney failure and alterations in the internal environment. Polyuria, urine output > 3 L/d or > 200 mL/min for more than 2 hours, can have multiple causes, and can be classified as osmotic, aqueous or mixed. Post-obstructive polyuria obeys different pathogenic mechanisms, which overlap and vary during a patient's evolution. Initially, there is a decrease in vasoconstrictor factors and an increase in renal blood flow, which, added to the excess of urea accumulated, will cause intense osmotic diuresis (osmotic polyuria due to urea). Added to these factors are the positive sodium and water balance during acute renal failure, plus the contributions of crystalloid solutions to replace diuresis (ionic osmotic polyuria). Finally, there may be tubular dysfunction and decreased solutes in the renal medullary interstitium, adding resistance to the action of vasopressin. The latter causes a loss of free water (mixed polyuria). We present the case of a patient with post-obstructive polyuria where, by analyzing the clinical symptoms and laboratory alterations, it was possible to interpret the mechanisms of polyuria and administer appropriate treatment for the pathogenic mechanism.


Assuntos
Poliúria , Humanos , Masculino , Poliúria/fisiopatologia , Poliúria/etiologia , Obstrução Ureteral/fisiopatologia , Obstrução Ureteral/complicações , Obstrução Uretral/fisiopatologia , Pessoa de Meia-Idade
5.
Rev Med Chil ; 150(2): 172-177, 2022 Feb.
Artigo em Espanhol | MEDLINE | ID: mdl-36156642

RESUMO

BACKGROUND: Upper urinary tract urothelial carcinoma (UTUC) represents 5-10% of urothelial carcinomas. It is managed with nephroureterectomy (NUR); however, kidney-sparing techniques are growingly used. AIM: To report the results of a 20-year series of NUR conducted in an academic center. PATIENTS AND METHODS: Review of clinical and pathological characteristics of patients undergoing NUR between 1999 and 2020. Patients were followed for 63 months. Global survival curves (OS) and mortality predictors were established through Cox regression. RESULTS: We included 90 patients with a median age of 68 years undergoing NUR, of whom 68 (75%) had a pelvic tumor and 22 (25%) had a proximal ureteral tumor. A laparoscopic NUR was performed in 60 patients (66%). Thirty-three patients (37%) had tumors confined to the urothelium (pTa), penetrating the lamina propria (pT1) or carcinoma in situ (CIS), 10 patients (11%) had a tumor spreading to the muscle layer (pT2) and 47 (52%) had a tumor spreading to nearby organs (pT3 / T4). Average tumor size was 3.69 cm, nodal disease (pN) was present 12 patients (13%). Twelve patients (13%) received adjuvant chemotherapy. A higher mortality was observed among smokers (Hazard ratio (HR) 8.79, 95% confidence intervals (CI) 1.5-49.0, p = 0.01), patients with tumors classfied as pT≥ 2 (HR 1.09, 95% CI 0.01-1.0, p = 0.04) and those with tumors larger than 2 cm (HR 14.79, CI 95% 1.5-272, p = 0.01). CONCLUSIONS: Smoking patients, those with invasive tumors (T2-T4) and greater than 2 cm have higher mortality. Therefore, they should not be candidates for conservative management.


Assuntos
Carcinoma de Células de Transição , Neoplasias Renais , Neoplasias Ureterais , Neoplasias da Bexiga Urinária , Idoso , Carcinoma de Células de Transição/patologia , Carcinoma de Células de Transição/cirurgia , Humanos , Rim/patologia , Neoplasias Renais/cirurgia , Nefroureterectomia , Prognóstico , Estudos Retrospectivos , Neoplasias Ureterais/patologia , Neoplasias Ureterais/cirurgia , Neoplasias da Bexiga Urinária/cirurgia
6.
Rev. med. Chile ; 150(8): 994-999, ago. 2022. tab, graf
Artigo em Espanhol | LILACS | ID: biblio-1431880

RESUMO

BACKGROUND: Vena cava (VC) involvement in kidney tumors occurs in 4 to 10% of cases, and is associated with a higher mortality. Nephrectomy with thrombectomy of the VC, performed by a multidisciplinary team, improves survival. Aim: To report a series of consecutive nephrectomies with caval thrombectomy performed in an academic center. PATIENTS AND METHODS: We report 32 patients with cT3b and 3c renal tumors, who underwent radical nephrectomy with VC thrombectomy between 2001 and 2021. A descriptive analysis of clinical, surgical and pathological variables was performed. Overall survival (OS) and cancer-specific survival (CSS) was calculated using Kaplan-Meier curves. Results: The mean tumor size was 9.7 cm. According to Mayo classification 3/32 (9%) patients had a type I thrombus, 10/32 (31%) had a type II thrombus, 8/32 (25%) had a type III thrombus, and 5/32 (16%) had a type IV thrombus. The mean bleeding was 2000 cc. There was one intraoperative death. Nineteen percent of patients had complications >= 3 according to Clavien-Dindo classification. Reoperations occurred in 9%. Pre and postoperative creatinine levels were 1.17 and 1.91 mg/dl respectively (p < 0.01). Pre and postoperative Hematocrit levels were 47.9 and 31% respectively (p = 0.02). Sixty six percent of tumors were clear cell renal cancer, 9% were papillary and 3% were chromophobic. Mean OS was 10 months. Two-year SCE was 40%. CONCLUSIONS: Our results are similar to those reported elsewhere. Despite being an unusual pathology, the surgical technique has been improving, thanks to the multidisciplinary work of urologists and surgeons.


Assuntos
Humanos , Trombose/cirurgia , Trombose/complicações , Carcinoma de Células Renais/cirurgia , Carcinoma de Células Renais/patologia , Neoplasias Renais/cirurgia , Neoplasias Renais/patologia , Veia Cava Inferior/cirurgia , Estudos Retrospectivos , Trombectomia/métodos , Nefrectomia/efeitos adversos , Nefrectomia/métodos
7.
Urol Case Rep ; 42: 102020, 2022 May.
Artigo em Inglês | MEDLINE | ID: mdl-35530559

RESUMO

Introduction: Retroperitoneal hematomas are rare complications of radical inguinal orchiectomy. This case report discusses their radiological differential diagnosis and management. Case presentation: A radical inguinal orchiectomy was performed on a 27-year-old patient. After discharge, he referred back pain. Computed tomography showed a retroperitoneal hematoma. A conservative approach was decided. Discussion: Traditionally, retroperitoneal hematomas have been considered possible radiologic pitfalls, which has therapeutical implications. This pitfall seems less likely in contemporary clinical practice.A conservative approach is preferred in stable patients, whereas active management should be offered to unstable patients. Conclusion: Future studies are necessary to offer evidence-based therapeutical options.

8.
Rev. méd. Chile ; 150(2): 172-177, feb. 2022. ilus, tab
Artigo em Espanhol | LILACS | ID: biblio-1389638

RESUMO

BACKGROUND: Upper urinary tract urothelial carcinoma (UTUC) represents 5-10% of urothelial carcinomas. It is managed with nephroureterectomy (NUR); however, kidney-sparing techniques are growingly used. AIM: To report the results of a 20-year series of NUR conducted in an academic center. Patients and Methods: Review of clinical and pathological characteristics of patients undergoing NUR between 1999 and 2020. Patients were followed for 63 months. Global survival curves (OS) and mortality predictors were established through Cox regression. RESULTS: We included 90 patients with a median age of 68 years undergoing NUR, of whom 68 (75%) had a pelvic tumor and 22 (25%) had a proximal ureteral tumor. A laparoscopic NUR was performed in 60 patients (66%). Thirty-three patients (37%) had tumors confined to the urothelium (pTa), penetrating the lamina propria (pT1) or carcinoma in situ (CIS), 10 patients (11%) had a tumor spreading to the muscle layer (pT2) and 47 (52%) had a tumor spreading to nearby organs (pT3 / T4). Average tumor size was 3.69 cm, nodal disease (pN) was present 12 patients (13%). Twelve patients (13%) received adjuvant chemotherapy. A higher mortality was observed among smokers (Hazard ratio (HR) 8.79, 95% confidence intervals (CI) 1.5-49.0, p = 0.01), patients with tumors classfied as pT≥ 2 (HR 1.09, 95% CI 0.01-1.0, p = 0.04) and those with tumors larger than 2 cm (HR 14.79, CI 95% 1.5-272, p = 0.01). CONCLUSIONS: Smoking patients, those with invasive tumors (T2-T4) and greater than 2 cm have higher mortality. Therefore, they should not be candidates for conservative management.


Assuntos
Humanos , Idoso , Neoplasias Ureterais/cirurgia , Neoplasias Ureterais/patologia , Neoplasias da Bexiga Urinária/cirurgia , Carcinoma de Células de Transição/cirurgia , Carcinoma de Células de Transição/patologia , Neoplasias Renais/cirurgia , Prognóstico , Estudos Retrospectivos , Nefroureterectomia
9.
J Clin Endocrinol Metab ; 107(5): e1946-e1953, 2022 04 19.
Artigo em Inglês | MEDLINE | ID: mdl-35020922

RESUMO

CONTEXT: Incidentally discovered adrenal adenomas are common. Assessment for possible autonomous cortisol excess (ACS) is warranted for all adrenal adenomas, given the association with increased cardiometabolic disease. OBJECTIVE: To evaluate the discriminatory capacity of 3-dimensional volumetry on computed tomography (CT) to identify ACS. METHODS: Two radiologists, blinded to hormonal levels, prospectively analyzed CT images of 149 adult patients with unilateral, incidentally discovered, adrenal adenomas. Diameter and volumetry of the adenoma, volumetry of the contralateral adrenal gland, and the adenoma volume-to-contralateral gland volume (AV/CV) ratio were measured. ACS was defined as cortisol ≥ 1.8 mcg/dL after 1-mg dexamethasone suppression test (DST) and a morning ACTH ≤ 15. pg/mL. RESULTS: We observed that ACS was diagnosed in 35 (23.4%) patients. Cortisol post-DST was positively correlated with adenoma diameter and volume, and inversely correlated with contralateral adrenal gland volume. Cortisol post-DST was positively correlated with the AV/CV ratio (r = 0.46, P < 0.001) and ACTH was inversely correlated (r = -0.28, P < 0.001). The AV/CV ratio displayed the highest odds ratio (1.40; 95% CI, 1.18-1.65) and area under curve (0.91; 95% CI, 0.86-0.96) for predicting ACS. An AV/CV ratio ≥ 1 (48% of the cohort) had a sensitivity of 97% and a specificity of 70% to identify ACS. CONCLUSION: CT volumetry of adrenal adenomas and contralateral adrenal glands has a high discriminatory capacity to identify ACS. The combination of this simple and low-cost radiological phenotyping can supplement biochemical testing to substantially improve the identification of ACS.


Assuntos
Adenoma , Neoplasias das Glândulas Suprarrenais , Adenoma Adrenocortical , Adenoma/complicações , Adenoma/diagnóstico por imagem , Neoplasias das Glândulas Suprarrenais/complicações , Neoplasias das Glândulas Suprarrenais/diagnóstico por imagem , Adenoma Adrenocortical/complicações , Adenoma Adrenocortical/diagnóstico por imagem , Hormônio Adrenocorticotrópico , Adulto , Humanos , Hidrocortisona , Tomografia Computadorizada por Raios X
10.
Rev Med Chil ; 150(8): 994-999, 2022 Aug.
Artigo em Espanhol | MEDLINE | ID: mdl-37358146

RESUMO

BACKGROUND: Vena cava (VC) involvement in kidney tumors occurs in 4 to 10% of cases, and is associated with a higher mortality. Nephrectomy with thrombectomy of the VC, performed by a multidisciplinary team, improves survival. AIM: To report a series of consecutive nephrectomies with caval thrombectomy performed in an academic center. PATIENTS AND METHODS: We report 32 patients with cT3b and 3c renal tumors, who underwent radical nephrectomy with VC thrombectomy between 2001 and 2021. A descriptive analysis of clinical, surgical and pathological variables was performed. Overall survival (OS) and cancer-specific survival (CSS) was calculated using Kaplan-Meier curves. RESULTS: The mean tumor size was 9.7 cm. According to Mayo classification 3/32 (9%) patients had a type I thrombus, 10/32 (31%) had a type II thrombus, 8/32 (25%) had a type III thrombus, and 5/32 (16%) had a type IV thrombus. The mean bleeding was 2000 cc. There was one intraoperative death. Nineteen percent of patients had complications >= 3 according to Clavien-Dindo classification. Reoperations occurred in 9%. Pre and postoperative creatinine levels were 1.17 and 1.91 mg/dl respectively (p < 0.01). Pre and postoperative Hematocrit levels were 47.9 and 31% respectively (p = 0.02). Sixty six percent of tumors were clear cell renal cancer, 9% were papillary and 3% were chromophobic. Mean OS was 10 months. Two-year SCE was 40%. CONCLUSIONS: Our results are similar to those reported elsewhere. Despite being an unusual pathology, the surgical technique has been improving, thanks to the multidisciplinary work of urologists and surgeons.


Assuntos
Carcinoma de Células Renais , Neoplasias Renais , Trombose , Humanos , Veia Cava Inferior/cirurgia , Neoplasias Renais/cirurgia , Neoplasias Renais/patologia , Carcinoma de Células Renais/cirurgia , Carcinoma de Células Renais/patologia , Trombectomia/métodos , Trombose/complicações , Trombose/cirurgia , Nefrectomia/efeitos adversos , Nefrectomia/métodos , Estudos Retrospectivos
11.
J Endocr Soc ; 5(10): bvab073, 2021 Oct 01.
Artigo em Inglês | MEDLINE | ID: mdl-34377881

RESUMO

PURPOSE: Latin American reports on pheochromocytomas and paragangliomas (PPGLs) are scarce. Recent studies demonstrate changes in clinical presentation and management of these patients. Herein, we assessed the main characteristics of PPGL patients in our academic center over the past 4 decades. METHODS: Demographic, clinical, biochemical, and perioperative data from 105 PPGL patients were retrospectively and prospectively collected over the 1980-2019 period. Data were organized into 4 periods by decade. RESULTS: Age at diagnosis, gender, tumor size and percentage of bilaterality, percentage of paragangliomas, and metastases remained stable across the 4 decades. The proportion of genetic testing and incidentalomas increased in recent decades (all P < 0.001). Therefore, we compared PPGLs diagnosed as incidentalomas (36%) with those clinically suspected (64%). Incidentalomas had fewer adrenergic symptoms (38 vs. 62%; P < 0.001) and lower rates of hypertension (64% vs. 80%; P = 0.01) and hypertensive crisis (28% vs. 44%; P = 0.02); also, they had lower functionality (79% vs. 100%; P = 0.01) and lower catecholamines levels (8.4-fold vs. 12.5-fold above upper cutoffs; P = 0.04). Regarding management of all PPGLs over the decades, we observed significant increases in both perioperative doxazosin dose (P = 0.003) and laparoscopic approach rates (P < 0.001), along with a decrease in the length of hospital stays (P = 0.007). CONCLUSIONS: We observed a change in the clinical presentation of PPGL in recent decades, with a marked increase in incidental cases and milder symptoms. The implementation of a multidisciplinary program for adrenal disorders in our institution has translated into more timely diagnoses, more genetic testing, and improvements in perioperative management.

12.
JCO Glob Oncol ; 7: 671-685, 2021 05.
Artigo em Inglês | MEDLINE | ID: mdl-33974442

RESUMO

PURPOSE: To assess the effect of clinical and pathological variables on cancer-specific and overall survival (OS) in de novo metastatic patients from a collaborative of primarily Latin American countries. PATIENTS AND METHODS: Of 4,060 patients with renal cell carcinoma diagnosed between 1990 and 2015, a total of 530 (14.5%) had metastasis at clinical presentation. Relationships between clinical and pathological parameters and treatment-related outcomes were analyzed by Cox regression and the log-rank method. RESULTS: Of 530 patients, 184 (90.6%) had died of renal cell carcinoma. The median OS of the entire cohort was 24 months. American Society of Anesthesiology classification 3-4 (hazard ratio [HR]: 1.64), perirenal fat invasion (HR: 2.02), and ≥ 2 metastatic organ sites (HR: 2.19) were independent prognostic factors for 5-year OS in multivariable analyses. We created a risk group stratification with these variables: no adverse risk factors (favorable group), median OS not reached; one adverse factor (intermediate group), median OS 33 months (HR: 2.04); and two or three adverse factors (poor risk group), median OS 14 months (HR: 3.58). CONCLUSION: Our study defines novel prognostic factors that are relevant to a Latin American cohort. With external validation, these easily discerned clinical variables can be used to offer prognostic information across low- and middle-income countries.


Assuntos
Carcinoma de Células Renais , Neoplasias Renais , Humanos , América Latina/epidemiologia , Prognóstico , Resultado do Tratamento , Estados Unidos
13.
Urol J ; 18(3): 355-357, 2021 May 01.
Artigo em Inglês | MEDLINE | ID: mdl-33931847

RESUMO

INTRODUCTION: The SARS-CoV-2 infection has resulted in an unprecedented pandemic. Patients undergoing surgery are a group at risk of exposure. Also, patients with ongoing infection undergoing surgery may be more susceptible to developing complications. There is no significant data on surgical safety in the pandemic period. MATERIAL AND METHODS: Observational study based in a prospective database of urological oncological surgery. Data were obtained during the 2020 mandatory confinement period compared to the same period in 2019. The records were reviewed 45 days post-surgery. The objective was to compare surgical morbidity and mortality during the pandemic versus an average year in urological cancer surgery. RESULTS: During confinement period (2020), 85 patients underwent uro-oncology surgery, while in 2019, during the same period, 165. The Clavien-Dindo morbidity ≥3 in 2020 was 2.3% (n=2), and in 2019, it reached 6% (n=10). In 2020, 9 patients were readmitted (10.5%). One patient (1.1%) was re-interfered, with a perioperative mortality of 1.1%. In 2019, 21 patients (12.7%) were readmitted. Seventeen patients (10.3%) were re-interfered, with a perioperative mortality of 1.8%. The median number of days hospitalized was 2 (IQR=2) in 2020 and 3 (IQR=3) in 2019. No significant differences were found in population or morbimortality, except for reoperation in a normal year. CONCLUSION: Postoperative morbidity and mortality reported are lower than those shown in the literature concerning COVID-19 and similar to that historically reported by our centers. This study suggests that it is safe to operate patients with urological cancer following the appropriate protocols during a pandemic.


Assuntos
COVID-19/epidemiologia , Complicações Pós-Operatórias/epidemiologia , Neoplasias Urológicas/cirurgia , Procedimentos Cirúrgicos Urológicos/mortalidade , COVID-19/prevenção & controle , Chile/epidemiologia , Humanos , Incidência , Reoperação/estatística & dados numéricos , SARS-CoV-2 , Procedimentos Cirúrgicos Urológicos/estatística & dados numéricos
14.
BMC Urol ; 21(1): 50, 2021 Mar 30.
Artigo em Inglês | MEDLINE | ID: mdl-33785004

RESUMO

OBJECTIVES: To establish the role of BCG instillations in the incidence and mortality of COVID-19. PATIENTS AND METHODS: NMIBC patients in instillations with BCG (induction or maintenance) during 2019/2020 were included, establishing a COVID-19 group (with a diagnosis according to the national registry) and a control group (NO-COVID). The cumulative incidence (cases/total patients) and the case fatality rate (deaths/cases) were established, and compared with the national statistics for the same age group. T-test was used for continuous variables and Fisher's exact test for categorical variables. RESULTS: 175 patients were included. Eleven patients presented CIS (11/175, 6.3%), 84/175 (48.0%) Ta and 68/175 (38.9%) T1. Average number of instillations = 13.25 ± 7.4. One hundred sixty-seven patients (95.4%) had complete induction. Forty-three patients (cumulative incidence 24.6%) were diagnosed with COVID-19. There is no difference between COVID-19 and NO-COVID group in age, gender or proportion of maintenance completed. COVID-19 group fatality rate = 1/43 (2.3%). Accumulated Chilean incidence 70-79 years = 6.3%. Chilean fatality rate 70-79 years = 14%. CONCLUSIONS: According to our results, patients with NMIBC submitted to instillations with BCG have a lower case-fatality rate than the national registry of patients between 70 and 79 years (2.3% vs. 14%, respectively). Intravesical BCG could decrease the mortality due to COVID-19, so instillation schemes should not be suspended in a pandemic.


Assuntos
Adjuvantes Imunológicos/administração & dosagem , Vacina BCG/administração & dosagem , COVID-19/epidemiologia , Neoplasias da Bexiga Urinária/tratamento farmacológico , Administração Intravesical , Idoso , Idoso de 80 Anos ou mais , Estudos de Casos e Controles , Chile , Estudos de Coortes , Feminino , Humanos , Incidência , Masculino , Índice de Gravidade de Doença , Neoplasias da Bexiga Urinária/patologia
15.
ANZ J Surg ; 91(5): E298-E306, 2021 05.
Artigo em Inglês | MEDLINE | ID: mdl-33682291

RESUMO

BACKGROUND: There is an increasing interest in studying the impact of altered body composition parameters and colorectal cancer (CRC) treatment outcomes. The aim of this study is to explore the impact of computed tomography (CT)-measured visceral obesity, sarcopenia and myosteatosis on survival of non-metastatic CRC. METHODS: Consecutive patients with stage I-III CRC who underwent curative-intent treatment between January 2010 and December 2015 were included. By measuring the visceral fat area, and the skeletal muscle index and radiodensity in the pre-operative staging CT, patients were classified as visceral obese, sarcopenic or myosteatotic. The associations between CT-based body composition parameters and survival were assessed using log-rank tests and a Cox regression analysis. RESULTS: Of 359 patients, 263 (73.3%) were visceral obese, 85 (23.7%) sarcopenic and 80 (22.3%) myosteatotic. Overall (OS), cancer-specific (CSS) and disease-free survivals (DFS) at 5 years were 78.8%, 84.7% and 75%, respectively. Myosteatosis and the combination of myosteatosis and visceral obesity were associated with a reduced DFS (hazard ratio 1.67; 95% confidence interval 1.06-2.61 and hazard ratio 1.85; 95% confidence interval 1.15-2.96, respectively). However, after performing a multivariate analysis including other relevant clinicopathological factors, none of the body composition parameters were associated with any long-term outcome measures, even after stratifying by cancer stage. CONCLUSIONS: CT-measured body composition parameters do not independently influence survival in non-metastatic CRC. There is a need for larger cohort studies with standardized patient selection and methodology to confirm these findings.


Assuntos
Neoplasias Colorretais , Sarcopenia , Composição Corporal , Neoplasias Colorretais/complicações , Neoplasias Colorretais/diagnóstico por imagem , Neoplasias Colorretais/patologia , Humanos , Músculo Esquelético/patologia , Prognóstico , Estudos Retrospectivos , Sarcopenia/diagnóstico por imagem , Tomografia Computadorizada por Raios X
16.
Updates Surg ; 73(1): 93-100, 2021 Feb.
Artigo em Inglês | MEDLINE | ID: mdl-32607844

RESUMO

Reconstruction after laparoscopic right colectomy (LRC) can be achieved by performing an intracorporeal (IA) or an extracorporeal anastomosis (EA). This study aims to assess the safety of implementing IA in LRC, and to compare its perioperative outcomes with EA during an institution's learning curve. Patients undergoing elective LRC with IA or EA in a teaching university hospital between January 2015 and December 2018 were included. Demographic, clinical, perioperative and histopathological data were collated and outcomes investigated. One hundred and twenty-two patients were included; forty-three (35.2%) had an IA. The main indication for surgery was cancer in both groups (83.7% for IA and 79.8% for EA; p = 0.50). Operative time was longer for IA (180 [150-205] versus 150 [120-180] minutes; p < 0.001). A Pfannenstiel incision was used as extraction site in 97.7% of patients receiving an IA; while a midline incision was used in 97.5% of patients having an EA (p < 0.001). Hospital stay was significantly shorter for IA (3 [3, 4] versus 4 [3-6] days; p = 0.003). There were no differences in postoperative complications rates between groups. There was a 4.7% and 3.8% anastomotic leak rate in the IA and EA group, respectively (p = 1). Re-intervention and readmission rates were similar between groups, and there was no mortality during the study period. The implementation of IA in LRC is safe. Despite longer operative times, IA is associated with a shorter hospital stay when compared to EA in the setting of an institution's learning curve.


Assuntos
Anastomose Cirúrgica/métodos , Colectomia/métodos , Procedimentos Cirúrgicos Eletivos/métodos , Tempo de Internação/estatística & dados numéricos , Procedimentos de Cirurgia Plástica/métodos , Idoso , Fístula Anastomótica/epidemiologia , Neoplasias do Colo/cirurgia , Feminino , Humanos , Masculino , Pessoa de Meia-Idade , Duração da Cirurgia , Estudos Retrospectivos , Resultado do Tratamento
17.
Rev Med Chil ; 145(1): 75-84, 2017 Jan.
Artigo em Espanhol | MEDLINE | ID: mdl-28393975

RESUMO

Ulcerative Colitis (UC) is a chronic inflammatory disease involving the colon, with alternating periods of remission and activity. Exacerbations can be severe and associated with complications and mortality. Diagnosis of severe UC is based on clinical, biochemical and endoscopic variables. Patients with severe UC must be hospitalized. First line therapy is the use of intravenous corticoids which achieve clinical remission in most patients. However, 25% of patients will be refractory to corticoids, situation that should be evaluated at the third day of therapy. In patients without response, cytomegalovirus infection must be quickly ruled out to escalate to second line therapy with biological drugs or cyclosporine. Total colectomy must not be delayed if there is no response to second line therapy, if there is a contraindication for second line therapies or there are complications such as: megacolon, perforation or massive bleeding. An active management with quick escalation on therapy allows to decrease the prolonged exposure to corticoids, reduce colectomy rates and its perioperative complications.


Assuntos
Colite Ulcerativa/terapia , Doença Crônica , Colite Ulcerativa/diagnóstico por imagem , Endoscópios , Feminino , Humanos , Fatores de Risco , Índice de Gravidade de Doença
18.
Rev. méd. Chile ; 145(1): 75-84, ene. 2017. ilus, tab
Artigo em Espanhol | LILACS | ID: biblio-845508

RESUMO

Ulcerative Colitis (UC) is a chronic inflammatory disease involving the colon, with alternating periods of remission and activity. Exacerbations can be severe and associated with complications and mortality. Diagnosis of severe UC is based on clinical, biochemical and endoscopic variables. Patients with severe UC must be hospitalized. First line therapy is the use of intravenous corticoids which achieve clinical remission in most patients. However, 25% of patients will be refractory to corticoids, situation that should be evaluated at the third day of therapy. In patients without response, cytomegalovirus infection must be quickly ruled out to escalate to second line therapy with biological drugs or cyclosporine. Total colectomy must not be delayed if there is no response to second line therapy, if there is a contraindication for second line therapies or there are complications such as: megacolon, perforation or massive bleeding. An active management with quick escalation on therapy allows to decrease the prolonged exposure to corticoids, reduce colectomy rates and its perioperative complications.


Assuntos
Humanos , Feminino , Colite Ulcerativa/terapia , Índice de Gravidade de Doença , Colite Ulcerativa/diagnóstico por imagem , Doença Crônica , Fatores de Risco , Endoscópios
19.
Rev. méd. Chile ; 144(11): 1410-1416, nov. 2016. ilus, tab
Artigo em Espanhol | LILACS | ID: biblio-845462

RESUMO

Background: In patients suffering intestinal failure due to short bowel, the goal of an Intestinal Rehabilitation Program is to optimize and tailor all aspects of clinical management, and eventually, wean patients off lifelong parenteral nutrition. Aim: To report the results of our program in patients suffering intestinal failure. Patients and Methods: A registry of all patients referred to the Intestinal Failure unit between January 2009 and December 2015 was constructed. Initial work up included prior intestinal surgery, blood tests, endoscopic and imaging studies. Also demographic data, medical and surgical management as well as clinical follow-up, were registered. Results: Data from 14 consecutive patients aged 26 to 84 years (13 women) was reviewed. Mean length of remnant small bowel was 100 cm and they were on parenteral nutrition for a median of eight months. Seven of 14 patients had short bowel secondary to mesenteric vascular events (embolism/thrombosis). Medical management and autologous reconstruction of the bowel included jejuno-colic anastomosis in six, enterorraphies in three, entero-rectal anastomosis in two, lengthening procedures in two, ileo-colic anastomosis in one and reversal Roux-Y gastric bypass in one. Thirteen of 14 patients were weaned off parenteral nutrition. Conclusions: Our Multidisciplinary Intestinal Rehabilitation Program, allowed weaning most of the studied patients off parenteral nutrition.


Assuntos
Humanos , Masculino , Feminino , Adulto , Pessoa de Meia-Idade , Idoso , Idoso de 80 Anos ou mais , Equipe de Assistência ao Paciente , Síndrome do Intestino Curto/reabilitação , Síndrome do Intestino Curto/cirurgia , Síndrome do Intestino Curto/fisiopatologia , Procedimentos Cirúrgicos do Sistema Digestório/métodos , Avaliação Nutricional , Antropometria , Estudos Retrospectivos , Resultado do Tratamento , Nutrição Parenteral/métodos , Gerenciamento Clínico , Procedimentos de Cirurgia Plástica/métodos , Intestinos/cirurgia , Intestinos/fisiopatologia
20.
Rev. chil. cir ; 68(5): 368-372, oct. 2016. tab
Artigo em Espanhol | LILACS | ID: lil-797346

RESUMO

Objetivo: Analizar las diferencias en los resultados quirúrgicos entre 2 grupos en colitis ulcerosa: proctocolectomía, reservorio ileal y anastomosis reservorio-anal (RIARA), simultáneo con la proctocolectomía (grupo 1) o diferido (grupo 2). Material y método: Estudio retrospectivo en 126 pacientes sometidos a RIARA. En todos los pacientes se confeccionó un RIARA en «J¼, excepto en 4 que se hizo en «S¼. Todos fueron protegidos con ileostomía. Complicaciones Clavien-Dindo II-V fueron registradas. Resultados: Pacientes con una mediana de edad de 37 años (12-61), 72 eran de género femenino (57%). Se practicó proctocolectomía y RIARA en 24 pacientes (19%) y proctectomía y RIARA en 102 (81%). Se observaron complicaciones postoperatorias en 19 pacientes (13%). Infección de la herida y sepsis pelviana, en 4% respectivamente, fueron las más frecuentes. Tres pacientes fueron reintervenidos: 2 por hemoperitoneo y uno por necrosis isquémica del reservorio. No hubo mortalidad postoperatoria. No se observó diferencia significativa en la morbilidad postoperatoria entre los grupos. Se observaron complicaciones a largo plazo en 48 pacientes (38%): obstrucción intestinal en 18 pacientes (14%), fístula reservorio-vaginal (FRV) en 9 (12,5%), y reservoritis crónica en 8 (6,9%) fueron las más frecuentes. Al comparar los 2 grupos, se observó mayor frecuencia de FRV en el grupo 1 (p = 0,02). Conclusión: En este estudio no se demostró diferencia en la morbilidad postoperatoria entre el grupo 1 y 2. En los resultados alejados hubo mayor frecuencia significativa de FRV en el grupo 1.


Aim: To compare the surgical results of both groups: Simultaneous with the proctocolectomy (SRP) (group 1) or delayed after colectomy (DRP) (group 2). Material and methods: Retrospective study on 126 patients submitted to RP. All patients had a J-pouch, except 4 S. All of them protected with a loop ileostomy. The median time between colectomy and IPAA was 5 months (4-6 range). Clavien-Dindo II-V complications were registered. Results: 126 patients had IPAA. Age median 37 years (12-61 range); 72 (57%) women. SRP in 24 (19%) and DRP was performed in 102 (81%). Postoperative complications were recorded in 19 patients (13%). Wound infection and pelvic sepsis were observed in 4% each. Three patients needed early reoperation: two for hemoperitoneum and one for ischemic necrosis of the pouch. There was no post-operative mortality. No significant difference in 30 days postoperative complication rate was found between SRP and DRP. On long-term follow-up: Intestinal obstruction in 18 patients (14%), pouch-vaginal fistula (PVF) in 9 (12.5%) and chronic pouchitis in 8 (6.9%) were the most common complications. PVF was significantly more frequent on group 1. Conclusion: In this series, no significant difference was found in the early surgical results between group 1 and 2. In the long term, PVF was significantly more common in group 1.


Assuntos
Humanos , Masculino , Feminino , Criança , Adolescente , Adulto , Pessoa de Meia-Idade , Anastomose Cirúrgica/métodos , Colite Ulcerativa/cirurgia , Proctocolectomia Restauradora/métodos , Canal Anal/cirurgia , Complicações Pós-Operatórias , Estudos Retrospectivos , Seguimentos , Resultado do Tratamento , Proctocolectomia Restauradora/efeitos adversos , Bolsas Cólicas , Íleo/cirurgia
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